Whew, dusting off the old keyboard here.  Been a while.  But I had to share, this was too ridiculous. 4:30 this morning.  I was on call for General Surgery (and Pedi Surgery and Vascular Surgery and Trauma and ENT).  Other than a vascular patient who decided she wanted to try to die and hemorrhage on us (she's as okay as she can be, at least not bleeding like a stuck pig anymore) it was a pretty quiet nite. One of the joys of being the junior Surgery resident on call is...

Years ago, I frequented a gaming website's message board.  There was a particular character there who posted regularly.  His posts were often well thought out, eloquent, and quite entertaining to read.  He was easily one of the most popular members. However, he also had a habit of becoming rather fierce when discussing political issues.  Due to his status as a respected, long time member, he got away with murder.  There was a very strict "no personal attacks" rule...

So there are two of us here at Concord.  A 4th year and myself, the 2nd year.  We take call between the two of us and an ocassional day from the Family Practice intern.  Since the 4th year is going on vacation next week that means I get to help cover her call.  Sweet. That means I am on call 8 out of the next 14 days.  Awesome.  On call Monday, Wednesday, Friday, Sunday, Monday, Wednesday, Friday, Sunday.  I can't even pretend that is cool.  That su...

I can't help it.  I laugh out loud. I realize that when one is just getting into acting, he/she has to take the jobs they can get, but imagine the look on good old mom and dad's faces when you sit down with them and pop the tape/disc in.  "Here is my big debut!" "I have genital herpes." "And I don't." "And we want to keep it that way." Oh, the smiles, the joy, the tears.  They must be so proud!  "Our son just smiled and told the world he has genital herpes!  ...

Pain is an interesting thing.  Even more interesting is how different people react to pain.  Somewhere along the way, someone decided that pain should be considered the fifth vital sign, that we need to regularly ask our patients to "rate" their pain on the wonderful 10 point pain scale, and then treat them accordingly. Even better is the fact that this whole "pain as the fifth vital sign" thing has been demonstrated to be useless. But we still stick with it, so you get patients ...

/begin whine As I sit here in the hospital, answering moronic pages about stupid things, my wife is home, sick herself, taking care of a 4 year old and an almost 2 year old who are both puking. Thank goodness for parents who just happened to be out here visiting. Sometimes this whole call thing really sucks. /end whine

Over the course of your intern year, you really learn how to work with nurses.  Some nurse you know will call with the most stupid things.  It just seems they can't think for themselves.  Others, however, only call when it is important.  And when they call in the middle of the night, you better get your butt out of bed. I got one of those calls 1 am Tuesday morning. It was from a nurse on one of the surgical floors who has been doing this for years.  He is fantasti...

Stand your ground, don't back down. Sometimes you have no choice.  Sure, you have to pick your fights, or you will just burn out.  But sometimes you have to fight.  You have to push, pull, coerce and convince.  Sometimes it just ain't right that the patient stays another day.  Case in point: a patient we admitted just the other day. She was a trauma.  Accident on the slopes.  No major injuries, just some bumps and bruises.  But the head CT showed a v...

Rolling over and playing dead. It is a survival mechanism that has been around for centuries.  Convince the predator you are dead, no longer a threat, and there is a chance they will leave you alone.  It ain't survival of the fittest.  It's survival of the limpest.  It's no different in medicine.  With some patients, all you can do is play dead.  Case in point: a patient I had this week.  She had a pretty minor surgery.  It was a procedure that,...

I have previously pondered the subject of pimping in medical education.  As much as I may not like it, I recognize that it is a time honored tradition in medical education.  As such, I expect it, and even respect it just a bit (that is the masochist in me speaking). However, lately I have experienced an aspect of pimping I could do without.  Let me set the stage. I present a patient.  On trauma, many of our patients can be rather complex, as they often have injuries a...

Just over a year ago, after I finished all my residency interviews, I decided to grow my goatee.  Over years, I have had a beard, here and there, for a few weeks at a time.  I thought this would be the same.  But after a while, my goatee grew on me (pun intended). The next thing I knew, it was months later and I still had my little red beard.  Now, over a year later, it was still there, having metamorphosized from a Van Dyck to most recently a pure goatee, with no associat...

Not quite a year ago, I penned some thoughts on being in the ICU, and what it was like to walk with death .  This article is the natural evolution of that. "Dr. Jones, what was the time of death?" There is no need to look at the clock.  I already did.  And at that moment, I firmly fixed in my mind that hour and minute.  I know what time she died.  I was there.  In fact, I was the one who told the nurse to turn off her levophed, vasopressin, and dopamine (th...

Exactly one month ago I wrote a blog about closed doors and open windows.  Well that open window I mentioned?  It's closing. In fact, Friday afternoon, it closes officially, and we will walk away with the keys to our own (first!) house. I am thrilled.  I sat on the couch tonight, looking around our current apartment with such excitement.  It hasn't been a bad place to live, and honestly was exactly what we needed.  Close to the hospital, close to good friends, an...

The trial that is Cardiothoracic surgery is over.  Well, sort of.  I still have to (get to) go back for a couple more weeks this next 4 week block.  I am on vacation coverage for this next 4 weeks, meaning I get to fill in for the interns who are on vacation.  Next week: the ER. And say goodbye to sleeping well. Monday I work a 12 noon-12 midnight shift.  Tuesday I do the same.  No big deal.  But when I get home early Wednesday morning (probably aroun...

Every once in a while, a moment becomes indelibly etched into our psyches.  No matter what happens for the rest of our lives, these moments will forever be crisp and clear, in some cases disturbingly so. The call came early.  4 am to be precise.  Low blood pressure.  Nothing new, nothing too concerning for the most part.  There are lots of reasons a person's blood pressure can drop, some serious, some not too serious.  He was a dialysis patient.  Kidneys are...